Provider Demographics
NPI:1972586428
Name:JIMENEZ, ROXANNA (MD)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17203 EFFINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3721
Mailing Address - Country:US
Mailing Address - Phone:718-428-1708
Mailing Address - Fax:718-428-1708
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:MEDICINE DEPARTMENT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:718-963-8753
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258872207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine